Provider Demographics
NPI:1316254071
Name:THORNE, GREGORY S (RD/LD)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:S
Last Name:THORNE
Suffix:
Gender:M
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 RIVERSIDE DR
Mailing Address - Street 2:APT 3
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3064
Mailing Address - Country:US
Mailing Address - Phone:918-639-8268
Mailing Address - Fax:
Practice Address - Street 1:3903 RIVERSIDE DR
Practice Address - Street 2:APT 3
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3064
Practice Address - Country:US
Practice Address - Phone:918-639-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1645133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered